Provider Demographics
NPI:1437139292
Name:GOMEZ, ALFREDO F (CRNA)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:F
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1986 NE 35TH CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6255
Mailing Address - Country:US
Mailing Address - Phone:954-253-0932
Mailing Address - Fax:954-253-0932
Practice Address - Street 1:1725 N UNIVERSITY DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6089
Practice Address - Country:US
Practice Address - Phone:954-227-7760
Practice Address - Fax:954-227-9975
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2515132367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2239OtherBCBS OF FLORIDA
FL430050723OtherRAILROAD MEDICARE
FL302363000Medicaid
FLG2239MMedicare PIN
FLG2239XMedicare ID - Type Unspecified
FLG2239OtherBCBS OF FLORIDA